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To evaluate delivery outcomes of LGA infants of IDMs.
Observational study (2008-11) of all LGA infants (birthweight >90th% for GA) delivered to 144 mothers with pregestational diabetes (PGDM) and 157 mothers with GDM. Major malformations and GA <34 w pts were excluded. Primary outcome of interest was shoulder dystocia (SD) and associated morbidity.
A total of 301 births were identified. 104 women (34.6%) delivered via repeat cesarean delivery (CD) while 106 (35.2%) women underwent a primary CD (67 for macrosomia, 13 for FTP, 8 for breech presentation, 10 for nonreassuring fetal heart rate status, 8 other). A total of 91 women (30.2%) delivered vaginally, with 20 cases complicated by shoulder dystocia (22% of vaginal deliveries). No cases of brachial plexus injury or humeral/clavicular fracture occurred. Other neonatal morbidities included RDS/TTNB (55%), late preterm birth (35% of PGDMs and 24% of GDMs), 5 minute Apgar <6 (9 patients, 2 with severe depression), and neonatal hypoglycemia (Glc values <40 mg/dl, affected 68 pts once and 49 others at least twice). NICU admission occurred in 81% of PGDMs and 35% of GDMs, but 75% of these admissions were <48 hours in duration, usually for the indication of blood sugar monitoring.
We confirm a high frequency of SD in LGA IDMs delivered vaginally. Despite selection of a high proportion of cases for primary CD, SD occurred in 22% of all vaginal deliveries. A liberal approach to CD with suspected macrosomia in diabetic pregnancy cannot prevent all cases of SD in this high risk population.